Background Accelerated atherogenesis leading to increased incidence of cardiovascular (CV) mortality has been reported in patients with rheumatoid arthritis (RA). The search of tools that may identify high-risk RA patients who may benefit from active therapy to prevent CV events is of major importance.
Objectives To determine if the use of carotid ultrasonography (US) may improve the stratification of CV risk of patients with RA.
Methods A set of 370 consecutive patients without history of CV events was studied to assess carotid intima-media thickness (cIMT) and plaques. As previously proposed, CV risk was calculated according to the modified SCORE (mSCORE) for RA that was adapted by the application of a multiplier factor of 1.5 in those patients fulfilling ≥2 of 3 specific criteria.
Results The mean disease duration was9.8years, 250 (68%) had rheumatoid factor/anti-CCP positivity and 61 (17%) extra-articular manifestations. Forty-three were excluded because they had type 2 diabetes mellitus or severe chronic kidney disease. CV risk was categorized in the remaining 327 RA patients according to mSCORE: mild (96 cases; 29.3%), moderate (201; 61.5%) and high/very high risk (30; 9.2%). Only 5 patients were reclassified as having high/very high CV risk when the mSCORE was applied. Severe carotid US abnormalities (cIMT > 0.90 mm and/or plaques) were uncommon in patients with low mSCORE (13%). Nevertheless, in patients with moderate mSCORE severe carotid US abnormalities were observed in 63% of cases. Amodel that included a chart mSCORE risk ≥5% plus the presence of severe carotid US findings in patients with moderate mSCORE risk (≥1% and <5%) yielded high sensitivity for high/very high CV risk (93 [95% CI: 88- 96]).
Conclusions Carotid US assessment may be useful to establish the CV risk in RA, in particular in patients with moderate mSCORE.
Acknowledgements This study was supported by grants from “Fondo de Investigaciones Sanitarias” PI06/0024, PS09/00748 and PI12/00060 (Spain). This work was also partially supported by RETICS Program, RD08/0075 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest None Declared